Over the last four decades, intermittent catheterization has proven to be the single most important advance in the treatment of patients with refractory bladder problems causing either incontinence or inability to urinate. Clean intermittent catheterization (CIC) may be used as either a temporary means of managing your bladder while you are awaiting other therapies or as definitive treatment over a lifetime. Except in the most unusual of circumstances, you should do intermittent catheterization yourself and not rely on a nurse, aide or family member. If you do the catheterization yourself, it is called self intermittent catheterization (SIC). SIC is generally meant to replace normal urination, but sometimes, particularly if you are unable to urinate after surgery, you should try to urinate first, then catheterize yourself. Most authorities agree that when doing SIC, there is no need for sterile technique; there is no need for gloves; there is no need for antiseptic solutions and there is no need for antibiotics. All that is necessary is a catheter and some lubrication to allow easy insertion of the catheter into the urethra. The procedure is simple. You go into a bathroom, sit or stand, put a dab of lubricant on the tip of the catheter and insert the catheter into the penis and through the urethra into the bladder.
Once the catheter is inside the bladder urine will begin to flow out and you should keep the catheter in place until the urine stops flowing. You may assist the urine flow by pushing down on your abdomen; this will cause the urine to come out faster. In general, within the limits of comfort, the larger the size of the catheter the easier it is to insert and the faster the urine comes out. For that reason relatively larger sizes (16 – 18 french) are more desirable than smaller catheters (8 – 14 french).
In addition to being used for permanent management of a urinary problem, intermittent catheterization is very useful in patients for whom complete recovery is expected but has not yet occurred. This most commonly is the situation immediately after many different kinds of surgeries. Some patients after surgery, for whatever reason, are unable to urinate at all. Traditionally, this was managed by leaving an indwelling catheter in place, then removing the catheter when the doctor thinks that the patient ought to be able to void. Then, the patient would undergo a “voiding trial”. This means that after the catheter is removed you wait until urine builds up in your bladder and you have the urge to urinate. You’re then, for practical purposes, given one chance to urinate and if you can’t go, the catheter goes back in place for another several days. You can imagine the emotional and psychological trauma that accompanies this kind of treatment. It’s almost like a punishment: you’re given one chance to urinate and if you can’t, back in goes the catheter! This causes an incredible amount of pressure on the patient to urinate, and, under these circumstances he or she is very often unable to do so. Intermittent self-catheterizations completely avoids this problem. Using this technique you wait until you get the urge to urinate, you go into the bathroom and try. Whether or not you urinate, you then catheterize yourself and when the residual volumes are low enough catheterization can be discontinued. There is no psychological pressure to void because you know that you are in control and that you won’t have to walk around day to day with an indwelling catheter and then get only one chance to urinate once it’s removed.
Nearly everyone can learn to do intermittent catheterization. It is painless and not at all uncomfortable. For the vast majority of people who need to do intermittent catheterization, rather than being barbaric or a nuisance, it has been a godsend. It is the closest thing to normal urination that you can obtain. If you can’t urinate at all, there really isn’t any other alternative except for an indwelling catheter. If you’re hopelessly incontinent or in the bathroom 20 times a day urinating and or changing pads and diapers, you’re now in the bathroom three or four or five times a day and you’re confidently dry.
Quite to the contrary. Most patients who have the kinds of problems that require intermittent catheterization are already at considerable risk for developing urinary tract infections and most have had infections in the past. Although intermittent catheterization doesn’t insure against infections, the chances of developing infection are much, much less with intermittent catheterization than with either the way you’re urinating now or any other treatment method.
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